Identification Profile:

 Name of the Patient: Mr. Kajal Bhowmik

 Age: 62 Years
 Sex: Male
 Address: Srinagar, Manu Bazar, South Tripura
 Religion: Hindu
 Educational Status: Class VII Passed
 Marital Status: Married
 Occupation: Daily Labour
 Date Of Admission: 28/06/2024
 Time: 11.45Am
 Ward: Ortho Ward
 Unit: I
 IP Number: 20240050489
 Bed Number: 53
 Provisional Diagnosis: Right foot gangrene (Non healing ulcer)
 Under The Treatment Of: Prof. Dr.Rajib Debnath

Chief Complaints:

Mr. Kajal Bhowmikwas admitted in the TMC &Dr. BRAM Teaching Hospital, Hapania,
Agartala on 28/06/2024 at 11.45 am with the complaints of getting infection on right foot for last
1-1.5 months.

History Of Present Illness:

The patient was come with the complaints of getting infection on right foot for last 1-1.5 months.
The patient was admitted at Srinagar hospital with the infection from there he was admitted at
SantirBazar hospital then he came at this hospital.

On examination, the 2nd& 3rd toe is amputated on 01/06/24 & 06/06/24.

History of weight loss 1-2 months back.

History Of Past Illness:

There was no significant history of any communicable disease and psychological problems. He is
suffering from HTN from last 4-5 years under the medication of Tab Amlodec 5 mg.He is also
suffering from diabetes mellitus from last 1-1.5 months when he was going at hospital with the
foot infection.
Family History of Illness:

There was no significant history of any communicable disease, chronic disease, congenital or
psychological problems among the family members.

Personal Habits :

Mr. Kajal Bhowmikis non-vegetarian. He is not habituated to chewing pan. He is not habituated
to doing exercise.
Physical Examination :

Date – 13/06/2024

Time – 11.00 am

1. General Appearance
 Nourishment – Under Nourished
 Body Built – Thin
 Activity – Weak
2. Mental Status
 Consciousness – Conscious
 Look – Depressed
 Orientation – Well Oriented To Date, Place And Person
3. Posture
 Body Curves – Normal
 Movement – ROM (Flexion, Abduction, Adduction, Extension) Possible by the Patient
Self
4. Height– 5ft 2 Inch
5. Weight– 49 Kg
6. Vital Signs

Date Time Body Pulse Respiration Blood

Temperature Pressure
11/06/2024 11.00 am 98.6degree F 76 beats/min 20 140/90 mm
breaths/min Hg
12/06/2024 10.00 am 95.4degree F 78 beats/min 26 130/80 mm
breaths/min Hg
13/06/2024 11.00 am 98.6 degree F 74 beats/min 24 130/90 mm
breaths/min Hg
7. Skin Condition
 Colour – Brown
 Texture – Dryness
 Temperature – Normal
 Lesions – Absent
8. Head
 Cleanliness – Not Clean
 Condition Of Hair – Rough & Dry
 Pediculosis – Absent
9. Face– Depressed & Anxious
10. Eye
 Vision – Normal
 Eyebrow – Normally Present
 Conjunctiva – Normal Red
 Sclera – White
 Eyeball – Black
 Pupils – Dilate To The Dark And Constrict To The Light
11. Ears
 External Ears – No Discharge
 Placement – Bilaterally Symmetrical
 Hearing – Hears The Vibration Of Tuning Fork By Both Ears
12. Nose &Sinus
 External Nose – Discharge Present
 Nostrils – Moisture
 Nasal Septum – Normally Present
13. Mouth & Throat
 Odour – Absent
 Lips – Dry
 Teeth – All Teeth Are Not Present
 Tongue – Dry
 Gums – Normal

14. Neck
 Lymph Node – Normal
 Thyroid Gland – Not palpable
15. Thorax
 Chest Inspection – Normal
 Palpation – No Abnormalities Detected
 Auscultation – No Abnormalities Detected
16. Cardiovascular System
 S1-S2 Sound – Normal
 17. Abdomen
 Inspection – No Abnormalities Detected
 Palpation – No Abnormalities Detected
 Auscultation – Bowel Sound Heard
18. Extremities
 Any Lesion – Amputation done on the right 2nd& 3rd toe.
 Range Of Motion - ROM (Flexion, Abduction, Adduction, Extension) Possible by the
Patient Self but move from bed is not by the patient self.

Investigations Done:

Date Name of the investigation Findings in Normal value Remarks

client
29/05/24 BT 2’30”
CT 4’10”
Serum Urea 25.3mg% 13-50 Normal
Serum creatinine 1.2 mg% 0.5-1.5 Normal
Serum sodium 135 mmol/L 135-155 Normal
Serum potassium 4.7mmol/L 3.5-5.5

Liver function test 6.4 gm%

 Total protein 3.5 gm% 5.0-8.0 Normal
 Albumin 2.9 gm% 3.0-5.0 Normal
 Globulin 0.64 mg% 2.0-4.0 Normal
 Total bilirubin 0.16 mg% 0.2-1.2 Normal
 Direct 0.48 mg% 0.1-0.4 Normal
 Indirect 43 IU/L 0.2-0.8 Normal
 SGOT 58 IU/L 12-40 High
 SGPT 256 IU/L 7.0-40 High
 ALP 217 IU/L 50-460 Normal
GGT 12.2 gm% 5-40 High
Haemoglobin 14.91 13.0-17.5 Low
WBC 3.50-9.50 High
Differential leukocyte count 78.5%
 Neutrophil 11.3% 40.0-75.0 High
 Lymphocyte 2.0% 20.0-50.0 Low
 Monocyte 6.2% 3.0-10.0 Low
 Eosinophil 0.4-8.0 Normal

ESR
Blood glucose 42mm/hour
 Fasting 116 mg% 65-110
 PP 100 mg% 70-140 Normal
 Serum HbsAg
Serum HCV Non-reactive
HIV

Blood Sugar Fasting

01/06/24 68 mg% 65-110 Normal

Arterial Doppler study of right

04/06/24 lower limb Severe /
advanced
atherosclerotic
change in
arterial system
of right lower
limb with
occlusion.

Medical Management:

Sl Name of the Dose Route Freque Mechanism of action

no drug ncy
1 Tab. Zincostar 1 tab Oral OD/PC By supplementing with these medications,
individuals can support their overall health and well-
being, improve energy levels, enhance immune
system function, support cellular and tissue repair,
and promote the optimal functioning of various
bodily processes.
2 Tab. Gabaday 100 Oral OD/HS Mechanism unknown; may increase seizure
Forte mg threshold; structurally similar
to GABA; gabapentin binding sites in neocortex,
hippocampus
Therapeutic outcome: Decreased seizure activity
3 Tab. Glycomet 500 Oral ABF Inhibits hepatic glucose production and
mg increases sensitivity of peripheral tissue
to insulin
Therapeutic outcome: Blood glucose at
normal levels
4 Cap.Pantocid 40 mg IV OD/AC Acts by reducing the stomach acid by blocking the
DSR actions of an enzyme (H+/K+ ATPase or gastric
(Pantoprazole) proton pump). This proton pump lies in the cells of
the stomach wall responsible for the release of the
gastric acid secretion, damaging tissues in the food
pipe, stomach and duodenum.
5 Tab. Limcee 500 Oral OD/PC Ascorbic acid functions as a cofactor, enzyme
mg complement, co-substrate, and a powerful anti-
oxidant in various reactions and metabolic processes.
It also stabilizes vitamin E and folic acid and
enhances iron absorption.
6 Tab. Eslo 2.5 Oral ABF Inhibits calcium ion influx across cell membrane
(Amlodipine mg OD during cardiac depolarization, produces relaxation of
tablets) coronary vascular smooth muscle, dilates coronary
vascular arteries, increases myocardial 02 delivery in
patients with vasospastic angina
7 Tab. Stiloz 50 mg Oral BD/PC Multifactorial effects (antithrombotic, antiplatelet
vasodilation)
Therapeutic outcome: Increased walking distance

Health Education:

Conclusion:
Gangrene is a serious condition where a loss of blood supply causes body tissue to die. It can
affect any part of the body but typically starts in the toes, feet, fingers and hands. Gangrene can
occur as a result of an injury, infection or a long-term condition that affects blood circulation.

A condition that can damage the blood vessels and affect blood flow, such as diabetes or
hardened arteries (atherosclerosis), increases the risk of gangrene.

Treatments for gangrene may include antibiotics, oxygen therapy, and surgery to restore blood
flow and remove dead tissue. The earlier gangrene is identified and treated, the better the
chances for recovery.
TRIPURA COLLEGE OF NURSING
Hapania, Agartala

Clinical Practice
On
Foot Gangrene
(Ortho Ward)
 Submitted To Submitted By
Miss. Manaswi Debbarma Manisha Paul
Asst. Prof. of TCN Roll no-04
M.Sc. Nursing 2nd Semester